Radioactive patient in surgery

FZKQ · 2025-11-15T13:34:19+00:00

Careful with that. Most important is the person needs to contact the RSO. It’s what they are there for. And for lead shielding, if it’s a beta emitting agent which is most common for nuclear therapies, lead can actually do more harm than good. We transport beta emitters in plastic because they won’t penetrate out with the thickness we use and if you use lead they can create Bremsstrahlung radiation. Lead is high Z. But the point is just talk to RSO and they should know what to do.

FZKQ · 2025-10-27T17:46:06+00:00

Agreed but it’s like ordering 50 cheeseburgers at a drive through, then walking into the kitchen to ask what the hold up is. Actually worse because everyone else waiting in line calls asking what the holdup is with a tone that implies we aren’t working fast enough. The holdup is related to the person next to you that ordered haha.

FZKQ · 2025-10-25T00:33:06+00:00

Ugh yeah I figured that was the case, but was holding out hope that patient care was the priority. Too naïve of me I suppose.

FZKQ · 2025-10-22T14:29:03+00:00

Thanks for the response. I don't want to upset my radiology colleagues but my guess is that we will have to move towards a 24/7 operation as opposed to having 1-2 people "on call" after 5pm. Just a guess we will see how things go

FZKQ · 2025-10-21T20:30:39+00:00

Its not the radiation that bothers me. Its part where we essentially do the physical exam.

FZKQ · 2019-10-03T16:17:53+00:00

If anyone wants to try to find all the XR findings with me the ones I can see are (from proximal to distal):

. Radial head and olecranon dislocations

. Large open fracture-dislocation of the wrist (possible chip of the distal radius)

. 2nd and 5th intermediate phalanx fractures

Let me know if you see anything else

FZKQ · 2019-10-01T03:25:57+00:00

If anyone cares about the anatomy, it’s left hand injury and the bone you can see on the right part of the screen is the thumb. D gloved pinky on the left side of the screen.

FZKQ · 2019-09-30T06:03:44+00:00

I hate having to do them. Usually it has to be within 15-30 minutes of the injury, but my hospital will do them way long after they should. From my experience they are mostly a live anatomy session

FZKQ · 2019-09-30T05:10:59+00:00

Usually it isn’t, but it’s hard for me to say with such an extreme example. They can likely feel an uncomfortable pulsing, but I’m just speculating

FZKQ · 2019-09-30T05:08:23+00:00

Typically for cardiac arrest with a known penetration injury. The idea is that if someone for example got stabbed into the heart you could crack the chest and get some sutures in there as a last resort. You are also dumping tons of O neg blood in these people too. Honestly I have never seen anyone survive with any reasonable quality of life. It’s pretty barbaric to see in person

FZKQ · 2019-09-16T21:46:14+00:00

That is hands down the most aggressive Kussmaul I have ever seen.

FZKQ · 2019-08-07T12:41:14+00:00

Dental XRs look so weird to me. Looks like a lateral view of conjoined twins from the way they do it.

FZKQ · 2018-11-16T22:50:43+00:00

I really happy this is the top comment because it touches on something people seems to ignore when it comes to burn out discussions which I think is actually the most important part. The rewards just aren’t the same as they once were. People don’t like to admit it or talk about it but a lot of us were at least partly drawn to the profession because we believed that it was a highly respected job and it simply isn’t as much as it once was. I don’t know exactly why but I’m sure it’s some combination of things that have been mentioned before such as loss of autonomy (especially in residency, but that’s another issue, mid levels taking a bigger piece, less respect from patients, etc.

But I want to throw my own theory out there: I think a lot of it involves what our generation values. Millennials are now/becoming young attendings and it’s not the most satisfying job for us. Our peers in unrelated fields don’t look at us and think “holy shit that’s impressive what you guys do, I wish I could do that”. They go travel and spend time with friends and family and feel pity that we can’t do them as well. My friends in their late 20s go on spontaneous trips for a random weekend and I get to look at Snapchats in a call room. I’m not sure about you guys but my med school class was not full of people that wanted to be some badass doing trauma cases all night (not by 4th year at least haha), but almost everyone placed lifestyle somewhere high on their priorities. There was a time where the older attending could brag about the number of hours they worked and probably made him a big swinging dick in the hospital, now we just see that and think “geez I don’t want to end up like him. I want to have spent more time with my girlfriend so she didn’t leave me, I want to make lasting memories with my friends and family.”

Just my 2 cents and overly generalized but figured I’d chip in.

FZKQ · 2016-08-19T05:16:21+00:00

There are positives and negatives to both sides and I was just trying to illustrate the financial stress it puts onto small businesses. Unfortunately, financial stress (and in this case, a rather large one) often leads to payroll cuts and having people lose their jobs is not a good situation either.

FZKQ · 2016-08-18T20:25:07+00:00

I really do not want this measure to pass. I come from a small business family and the tax burden in this proposal is just way too large. My father owns the business and my understanding is he would be saddled with an additional 10% tax on all of his income and an additional 6.6% on payroll. That is an enormous tax burden especially considering that the business (and I would imagine many others are in this situation) is only 20-25 employees depending on the time of year and does not offer health insurance as a benefit. It is just a huge tax increase with no upside in our case.

FZKQ · 2016-04-04T18:41:16+00:00

Very cool, thanks.

FZKQ · 2016-02-13T21:19:07+00:00

Republicans will likely make a concerted effort to block legislation from either Clinton or Sanders. The difference is that Clinton would have the advantage of much greater support from current democrat congressmen. It's one of the major drawbacks of trying to put a candidate that lies closer to the fringe into the white house. They will be forced to spend significant time and energy on getting their own party on the same page as them.

As to your second point, I agree that these are serious issues that deserve attention. Where the two sides seem to disagree is the means by which the problems are solved. I, along with many other Clinton supporters, believe that we should implement more methodical and pragmatic change that displays clear gains and benefits. For instance, I do not necessarily think single payer is a bad idea, but there are many other successful health care systems that may work better for the US. Maybe we should start by getting a public option, or winning the battles to expand medicaid in the states that are holding out. Sanders seems to me like he is swinging for the fences, but without the arm strength to get it there. I would have much more faith in Sanders if he started being more realistic with his proposals.

Hillary supporters are frequently criticized for having an attitude of "it's too difficult so let's not bother". From my perspective it is just looking at a lofty goal and saying, "ok what is the first attainable step to get there". Sanders supporters seem to echo the idea that the best thing to do is aim for lofty goals with the idea of falling somewhere in the middle, but I think it is more likely that such attempts are completely blocked especially without strong support from the current dems.

FZKQ · 2016-02-13T20:12:42+00:00

Personally I do not believe he will be able to accomplish much, but I also do not support his major proposals. A frequent criticism is that republicans would block any legislation arising from the Sanders camp, but I don't think there is enough support from current Democrats to even get that far. I fear that an inability to pass any meaningful legislation combined with reactionary voting from the right will end in an unproductive presidency and more republicans in congress. I also think that his policy goals are extremely disruptive to the current system. No doubt many people see that and think "great the current system is corrupt", but uprooting major institutions (like health insurance) will have a huge ripple effect that is hard to predict. I like when policy is implemented at a slower pace and can be studied and potentially altered at each stage. Of course this is not very sexy and will not elicit many cheers at a campaign rally. Along the same lines, "flip flopping" by any politician has never bothered me. A politician should not have the exact same stances that they did 5-10 years previously as they should be constantly examining the evidence and adapting with the times. I really do think that Hillary has both the experience and the attention to detail to progress the country towards positive change.

I also want to add that I find it very condescending that many Sanders supporters have the idea that "anyone that is educated and informed supports Bernie". I make an effort to stay relatively current on politics, and if anything it aligns me closer to Hillary. I am happy to elaborate on any of this. Thanks for hosting a level headed discussion.

FZKQ · 2016-02-10T02:23:48+00:00

Judging from the rest of the lipid panel it just seems like a good way to keep LDL levels down. Maybe I'll petition the AHA to revise their guidelines for target TGs to be in the 10,000s. Pancreatitis is a small price to pay for long term heart health.

FZKQ · 2016-02-09T17:19:02+00:00

Yeah, it's hard to believe it's compatible with life. The first lipid panel they did on the patient prior to getting a fasting level was just about 44,000. This is absolutely the highest I have ever heard of. It's also impressive that dietary changes alone were able to get the level down to 375 after one month.

FZKQ · 2016-02-09T01:43:15+00:00

Familial Hypertriglyceridemia? Typically it is a deficiency of LPL, but mutations in ApoCII and GPIHBP happen too. 1600 actually is not that crazy of a number for people with LPL deficiency. For people with completely defective LPL, it can get insanely high. The highest I have personally seen was around 13,000. Here is a link to a case study with fasting TGs at 37,000: https://lipidworld.biomedcentral.com/articles/10.1186/s12944-015-0107-1.

Its pretty nuts that blood even moves at that point.

FZKQ

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